Nationwide Trends in Tube-Related Genitourinary Interventions for Medicare Beneficiaries

Ende, Elizabeth Von; Gayou, Edward L.; Dowell, Joshua D.; Waid, M.; Chaves, Laura; Rula, Elizabeth Y.; Makary, Mina S.

doi:10.1016/j.jacr.2021.04.015

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…Previous work has demonstrated that prolonged catheterization may increase the risk of urethral erosions. 15,16 Even for surgeons who employ catheters for 24 hours or less, catheters may represent a motivation for admission. Some patients and providers alike may feel uncomfortable with a patient managing catheters outpatient in the immediate postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Multicenter Observational Study of Immediate Voiding at End of Urinary Sphincter Surgery (REMOVE)

Kozar,

Kaylor,

Hinderscheid

et al. 2023

Journal of Urology

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Purpose:Patients may remain catheterized after artificial urinary sphincter surgery to prevent urinary retention, despite a lack of evidence to support this practice. Our study aims to evaluate the feasibility of outpatient, catheter-free continence surgery using a multi-institutional database. We hypothesize that between catheterized controls and patients without a catheter, there would be no difference in the rate of urinary retention or postoperative complications.Materials and Methods:We conducted a retrospective review of patients undergoing first-time artificial urinary sphincter placement from 2009-2021. Patients were stratified by postoperative catheter status into either no-catheter (leaving the procedure without a catheter) or catheter (postoperative indwelling catheter for ∼24 hours). The primary outcome, urinary retention, was defined as catheterization due to subjective voiding difficulty or documented postvoid residual over 250 mL.Results:Our study identified 302 catheter and 123 no-catheter patients. Twenty (6.6%) catheter and 9 (7.3%) no-catheter patients developed urinary retention (P = .8). On multivariable analysis, controlling for age, cuff size, radiation history and surgeon, there was no statistically significant association between omitting a catheter and urinary retention (OR: 0.45, 95% CI: 0.13-1.58; P = .2). Furthermore, at 30 months follow-up, Kaplan-Meier survival analysis revealed that device survival was 70% (95% CI: 62%-76%) vs 69% (95% CI: 48%-82%) for the catheter and no-catheter group, respectively.Conclusions:In our multi-institutional cohort, overall retention rates were low (7%) in groups with a catheter and without. Obviating postoperative catheterization facilitates outpatient incontinence surgery without altering reoperation over medium-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Retrospective Multicenter Observational Study of Immediate Voiding at End of Urinary Sphincter Surgery (REMOVE)

Kozar,

Kaylor,

Hinderscheid

et al. 2023

Journal of Urology

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“…IR use of ultrasound and fluoroscopy allow for high fidelity placement and replacement of nephrostomy tubes. IR performs a significant volume of nephrostomy tubes, comprising over 90% of nephrostomy tube claims according to Medicare data ( 104 ). When percutaneous access is gained, IR can do simultaneous pressure measurements with the Whitaker test to complement diuretic renography.…”

Section: Renalmentioning

confidence: 99%

“…Compared with nephrologists or urologists that may be achieving access blind or with ultrasound, the fluoroscopic feedback allows for safer and more cost-effective placement. Urology is more often the operator for the placement of nephro-ureteral tubes and ureteral stents ( 104 ). When stent placement requires retrograde access, urology has more expertise to operate, but IR can use similar methodology when tube and stent placement is delivered anterograde with percutaneous access.…”

Section: Renalmentioning

confidence: 99%

Value of interventional radiology and their contributions to modern medical systems

Campbell,

Chick,

Shin

et al. 2024

Front. Radiol.

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Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.

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Nationwide Trends in Tube-Related Genitourinary Interventions for Medicare Beneficiaries

Cited by 2 publications

References 23 publications

Retrospective Multicenter Observational Study of Immediate Voiding at End of Urinary Sphincter Surgery (REMOVE)

Retrospective Multicenter Observational Study of Immediate Voiding at End of Urinary Sphincter Surgery (REMOVE)

Value of interventional radiology and their contributions to modern medical systems

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